Pages

Tuesday, February 25, 2014

landmines

My soon-to-be five year old will do or say anything to delay bedtime. Recently she's wanted me to tell her about my day – what type of patients I saw, where their cancers were, and who was bald. If the patient was female and not bald, she wants to know if the hair was short or long. If the patient was male, she wants to know if he had a mustache or a beard. Hair, who has it and where it is, seems very important in her understanding of what I do.

Because the nature of the inquiry is flattering, I usually linger a while at her bedside and try to recall the patients I saw in clinic. I am careful to choose the details that are not inherently upsetting, but the longer the talk, the more likely I am to stumble into territory littered with the landmines of subject matter unbefitting the ears of preschoolers, especially in the few minutes before bedtime.

When it comes to the question of how to and under what circumstances do we “shelter” our children, I think I fall somewhere in the middle. Although sex and violence might be part of life, I think it’s appropriate to limit my children’s exposure to those themes while they are young. I'm not sure I feel the same about medical illness and problems faced by people undergoing treatment for cancer. I was ten the first time I went to Guatemala and freaked out when children tapped on our car doors begging for money. Even though I remember that experience as a very negative one, in retrospect it was probably a good introduction to the topic of inequality. I share the story to make the point that exposure to uncomfortable subject matter can be an important part of growing up.

But 5 isn't 10 and death isn't poverty, and I am still unsure of what I should and should not share with my preschooler.

She’s quite interested in the subject of death, even more so than the subject of hair, and I wonder if it's precisely this interest that makes me uncomfortable. She knows that “old” people die, but asks questions that would indicate she suspects there’s something more to the subject. I’m not sure if she knows that anyone can die at any time, and, more to the matter, if she poses the emotional intelligence to deal with the obvious implications of that realization.

I’ve heard before that the best course of action when children ask potentially age inappropriate questions is to answer only the question posed, in as direct and simple a manner as possible. But she asks a lot of questions, and each answer seems to spurn on a new set of inquiries. I hate the feeling of lying to my daughter, but I do it occasionally to get myself out of discussion I’d rather not have.

There is just so much "real life" every day! You ask such a great question, leading to several more about handling questions in general, that I shall write a post instead of just a comment. Oh those children with just another way to delay bedtime: http://www.mothersinmedicine.com/2009/10/please-tell-me-more-about-how-heart.html

I agree it gets hairy. My daughter also often asks me to tell her "doctor house stories" at bedtime. Lately she is obsessed with operating on babies and she wants to see the babies and ask if I operate on what is inside their belly, etc, etc. This started with the finding of a gastroschisis baby in one of my texts. I do find my self derailing the conversation once she gets too caught in the details!

My four year old asked recently if kids die... Was he overhearing me talk about some of my patients to my husband? I'm not sure. It might just be a normal four year old question. I don't want to lie but I also don't want to freak him out. I'm not sure where to draw the line either so I'm interested to hear others' responses as well :)

Landmines is an interesting title indeed. I am an Army doctor. My kids go to a daycare on base. Every single day they go through the fully armed gates and most days we see at least one amputee. Some days we see kids pushing their parents in wheelchairs. I say this not to be overly dramatic. We are all shaped by how we grow up. Perhaps, your daughter will grow up thinking that she has the power to cure cancer, much as I did myself after seeing my grandfather die from the disease when I was a very young child. Perhaps my children will grow up to want to become pm&r docs. maybe they will want to be military police. We can't know what effects the exposures we have as young kids will have. I think you have to tell as much as you think answers their questions without being overly graphic. I've found that the answer that some people don't have legs is enough for my kids when asking why someone has a metal leg. I needn't go in to the details of the war with them. I think answering with the simplest details until they stop asking more is perfectly reasonable.

I'm a hospice doc. My daughter is now 14 and has a pretty clear idea what I do that has developed over the years; at first I told her I took care of people who were very ill and helped them feel better. When she was about 6, we went on vacation with my brother-in-law and our slightly older niece. At one point, the niece asked me if I took care of people who had heart disease. I said yes, I did. My daughter said "Mommy's patients all die". Our niece said "oh, auntie, I'm SURE you did your best. Don't feel bad".

To actually answer the question...I share as much as she wants to know, which is usually not a lot. My dad was a doc and he always answered my questions quite fully. I learned a great deal of medicine listening to him talk to my grandfather (his partner in internal medicine practice). The level may change depending on the age - there are always stories we can tell.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

Disclaimer

No content of this blog should be taken as medical advice. Any references to patients have been altered to maintain confidentiality. Content and links on personal blogs listed on the blogroll are not vetted or monitored and do not represent endorsements by Mothers in Medicine.